Provider Demographics
NPI:1063650703
Name:VOCK, TRACIE LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:LYNN
Last Name:VOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 FREE TER
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5900
Mailing Address - Country:US
Mailing Address - Phone:443-845-7486
Mailing Address - Fax:
Practice Address - Street 1:20251 CENTURY BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1162
Practice Address - Country:US
Practice Address - Phone:301-944-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005022363AM0700X
MDC0003927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical